<include file="Public:header" />

<div id="home">
    
    <div id="header">
        
        <div style="height:28px; padding-top:10px; background:url(__PUBLIC__/Front/images/xy.png) 10px 8px no-repeat" class="logo"><span onclick=" history.go(-1);">&nbsp;</span></div>
       
        <div class="shoptitle"><span>申请提现</span></div>
        
        <include file="Public:righttop" />
        
    </div>
    
</div>

<include file="Public:procat" />

<style type="text/css">
    .pw,.pwt{
        height:26px; line-height:normal;
        border: 1px solid #ddd;
        border-radius: 5px;
        background-color: #fff; padding-left:5px; padding-right:5px;
        -moz-border-radius:5px;/*仅Firefox支持，实现圆角效果*/
        -webkit-border-radius:5px;/*仅Safari,Chrome支持，实现圆角效果*/
        -khtml-border-radius:5px;/*仅Safari,Chrome支持，实现圆角效果*/
        border-radius:5px;/*仅Opera，Safari,Chrome支持，实现圆角效果*/
    }
    .pw{ width:90%;}
    .usertitle{
        height:22px; line-height:22px;color:#666; font-weight:bold; font-size:14px; padding:5px;
        border-radius: 5px;
        background-color: #ededed; padding-left:5px; padding-right:5px;
        -moz-border-radius:5px;/*仅Firefox支持，实现圆角效果*/
        -webkit-border-radius:5px;/*仅Safari,Chrome支持，实现圆角效果*/
        -khtml-border-radius:5px;/*仅Safari,Chrome支持，实现圆角效果*/
        border-radius:5px;/*仅Opera，Safari,Chrome支持，实现圆角效果*/
    }
    .pws{ background:#ededed}
</style>

<div id="main" style="min-height:300px">
    
    <div style="background:#f5f5f5; border-bottom:1px solid #d1d1d1;padding:10px;">
        
        <form name="USERINFO2" id="USERINFO2" action="{:U('WeChat/Member/cash')}" method="post">
            
            <table width="100%" border="0" cellpadding="0" cellspacing="0" style="line-height:30px;">
                
                <tr>
                    <td width="25%" align="right" style="padding-bottom:2px;"><b class="cr2">*</b> <font color="#999999">开户行：</font></td>
                    <td width="75%" align="left" style="padding-bottom:2px;">
                        <input readonly="" type="text" value="{$bank.bank}" name="bank"  class="pw pws"/></td>
                </tr>
                
                <tr>
                    <td width="25%" align="right" style="padding-bottom:2px;"><b class="cr2">*</b> <font color="#999999">支行：</font></td>
                    <td width="75%" align="left" style="padding-bottom:2px;">
                        <input readonly="" type="text" value="{$bank.province}-{$bank.city}-{$bank.branch}"  class="pw pws"/>
                        <input type="hidden" name="province" value="{$bank.province}"/>
                        <input type="hidden" name="city" value="{$bank.city}"/>
                        <input type="hidden" name="branch" value="{$bank.branch}"/>
                        <input type="hidden" name="user_id" value="{:is_login_wechat()}"/>
                    </td>
                </tr>
                
                <tr>
                    <td width="25%" align="right" style="padding-bottom:2px;"><b class="cr2">*</b> <font color="#999999">手机号：</font></td>
                    <td width="75%" align="left" style="padding-bottom:2px;">
                        <input readonly="" type="text" value="{$bank.phone}" name="phone"  class="pw pws"/></td>
                </tr>
                
                <tr>
                    <td width="25%" align="right" style="padding-bottom:2px;"><b class="cr2">*</b> <font color="#999999">户名：</font></td>
                    <td width="75%" align="left" style="padding-bottom:2px;">
                        <input readonly="" type="text" value="{$bank.name}" name="name"  class="pw pws"/></td>
                </tr>
                
                <tr>
                    <td width="25%" align="right" style="padding-bottom:2px;"><b class="cr2">*</b> <font color="#999999">卡号：</font></td>
                    <td width="75%" align="left" style="padding-bottom:2px;">
                        <input readonly="" type="text" value="{$bank.account}" name="account"  class="pw pws"/></td>
                </tr>
                
                <tr>
                    <td width="25%" align="right" style="padding-bottom:2px;"><b class="cr2">*</b> <font color="#999999">你的余额：</font></td>
                    <td width="75%" align="left" style="padding-bottom:2px;">
                        <input readonly="" type="text" value="{$balance}元"  class="pw pws"/>
                        <input readonly="" type="hidden" value="{$balance}" name="balance"/>
                    </td>
                </tr>
                
                <tr>
                    <td width="25%" align="right" style="padding-bottom:2px;"><b class="cr2">*</b> 提款资金：</td>
                    <td width="75%" align="left" style="padding-bottom:2px;">
                        <input type="text" value="" name="total"  class="pw" style="width:50%"/>元</td>
                </tr>
                
                <tr>
                    <td align="center" style="padding-top:10px;" colspan="2">
                        <a href="javascript:;" onclick="$('#USERINFO2').submit();"
                           style="border-radius:5px;display:block;background:#3083CE;cursor:pointer;
                           width:140px; height:25px; line-height:25px; font-size:14px; color:#FFF">确认提交</a>
                        <a href="{:U('WeChat/Member/bankCard')}" style="border-radius:5px;
                           display:block;background:#E13934;cursor:pointer;width:140px; height:25px; 
                           line-height:25px; font-size:14px; color:#FFF; margin-top:10px">修改提款信息</a>
                        <span class="returnmes2" style="padding-left:10px; color:#FF0000"></span>
                    </td>
                </tr>
                
            </table>
            
        </form>
        
    </div>

</div>

<include file="Public:footer" />